What is Plasma Exchange?
Plasma Exchange is where plasma, containing antibodies and proteins, is filtered out of your blood. You have two access points, one is where the blood is drained into the machine, and one where the blood is returned back to you, completing the circuit. When the blood is removed from your body, anti-coagulants are added to it to prevent clotting. The blood and plasma are then separated in the machine. This is done by spinning the blood, where the plasma and red blood cells begin to separate because of their different densities. Albumin, containing proteins from donor blood, is then added to your freshly filtered blood and returned back to you in the second access point.
Why Do I Get Plasma Exchange Done?
For me, ‘evil antibodies’ are destroying my body, produced by my very own immune system. Plasma Exchange removes the antibodies from my blood, to stop my immune system from attacking me. To be more specific, I use this to treat my confirmed Autonomic and Peripheral Neuropathy, that are suspect to be autoimmune. I also have suspected Small Fiber Neuropathy and Autoimmune Autonomic Ganglionopathy. The first three conditions are where my immune system creates antibodies that are damaging my nerves that interfere with nerve signals. The latter is where antibodies are blocking receptors sent out by my brain, specifically in my Autonomic Nervous System. Essentially, the messages my brain sends aren’t being received by the rest of my body. Think of it as broken telephone.
The fact that I respond to autoimmune treatment positively, somewhat proves that I have the above conditions. I also have Ulcerative Colitis, POTS, Orthostatic Hypotension, Gastritis, Gastroparesis, Sjogren’s and more. With this treatment, I went from being in a wheelchair to walking again! My body can now receive nerve signals from my brain that regulate my blood pressure, pulse, digestion, breathing and more which allow me to perform basic functions with ease again. Plasma Exchange isn’t a cure as it doesn’t stop my body from producing the evil antibodies, but it removes them which eases/stops the damage. It’s symptom management rather than a cure – but I’ll take whatever I can get.
How Exactly Is Plasma Exchange Done?
With Plasma Exchange, you have two access points. Typically, two large needles are placed into your arms. One is for blood output into the machine and one used to return your plasma-free blood back to you. The machine becomes part of your circulation circuit in a way.
As soon as your blood is removed, anti-coagulants are added to it to prevent clotting in the machine, specifically Citrate in my case. The blood is then spun, which separates the red blood cells from the plasma. The plasma is the pale yellow stuff in the bag at the back of the machine in my photo. Albumin in then added to your plasma free blood, and then it’s warmed to your body temperature and added back to your body.
For Plasma Exchange, large needles are needed as I mentioned above. This is because the blood cells can be damaged if its forced through smaller needles. Unfortunately, many people have unstable, small or difficult to find veins, which makes access through peripheral veins in the arms difficult. They have to resort to access through other means, such as a port or catheter.
How Else Can Plasma Exchange Be Done If You Have Inaccessible Veins?
On my first day of Plasma Exchange, I was to have treatment done through needle access in my arms. I got poked a million times and they couldn’t end up even using the right sized needles because my veins were too small. We managed to get the first day of treatment done, but immediately decided that we’d need to find another way to get access to my veins. Cue the central venous catheter, specifically a Hickman Line. There are other methods of accessing your veins, but I am personally just writing about what I have experienced, as I want to provide accurate information. I don’t want to try to write about things I don’t know much about and provide inaccurate information as this is serious stuff.
What is a Hickman Line?
This is a line where a single piece of tubing containing two separate lines is inserted into your jugular vein and goes down to your superior vena cava, which is essentially the entrance of your heart. The part that sticks out of your body is tubing with two separate entrances. It sticks out, as you can see in my photo.
In my case, the Hickman went straight into my jugular vein, but this can easily cause an infection. If the line becomes infected, it can easily turn into sepsis became the line goes straight to your heart. This can get dangerous fast. This can only stay in temporarily, for 7 – 10 days due to the high risk involved. You cannot shower nor swim because the tubing sticks out of your neck. If it gets wet, it can get infected.
However, there are Hickman Lines that can stay in longer. The line is inserted lower down on your chest, with the tubing tunnelled under your skin and then goes into your jugular vein. This decreases the chances of infection, as the incision isn’t directly into the vein. However, you still cannot swim nor shower with this in.
How Often Does One Need Treatment?
My temporary Hickman Line only stayed in for my 5 day round of my initial treatment. For conditions similar to mine, a 5 day round is done to clear the antibodies out of your blood in an aggressive manner. After that, your doctor will decide how often treatment needs to be done determined by how often your body creates more damaging antibodies or how often you relapse. Some people do a 5 day round treatment once and they are fine, that is all they need. Some people do treatment once a month, from a 5 day round to a single day round, sometimes even more. It truly varies per person. Some people do treatment every few months. I personally do treatment 1 – 2 times per week because of how quickly my body reproduces aggressive antibodies.